Preoperative Doppler assessment of perforator anatomy in the anterolateral thigh flap

Shaw, Richard; Batstone, Martin; Blackburn, Thomas R.; Brown, James S.

doi:10.1016/j.bjoms.2009.08.016

Cited by 52 publications

(31 citation statements)

References 10 publications

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“…A handheld unidirectional Doppler probe, while highly sensitive, frequently locates small perforators that may be insufficient to support a flap 9. In addition, sensitivity may also vary significantly with differential skin thickness 5 , 10. Computed tomographic angiography provides information as to the largest perforator to a specific area, but it does not provide dynamic information as to the actual perforator perfusion zones.…”

Section: Discussionmentioning

confidence: 99%

128: Laser-Assisted Indocyanine Green Imaging Optimizes the Design of the Anterolateral Thigh Flap

Sacks

et al. 2011

Plastic and Reconstructive Surgery

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Objective: The anterolateral thigh flap is a versatile flap that can be used in a free or pedicled fashion. Because of the large amount of potential soft tissue, low donor site morbidity, and long pedicle lengths, many researchers consider it to be the perfect free flap. However, dissection of this and other perforator flaps can become an arduous experience with learning curves to overcome. Near-infrared laser angiography using indocyanine green provides a useful adjunctive tool to more predictably assess direct perforator perfusion zones. Laser-assisted angiography with SPY-Q analysis gives live localization of the flap's dominant perforator perfusion zones while quantifying the relative tissue perfusion for immediate skin paddle design. Methods: Fifteen patients with head and neck cancer defects were reconstructed with a free anterolateral thigh flap using laser-assisted near-infrared indocyanine green perforator mapping. The mid-point of a line between the anterior superior iliac spine and the patella was determined and the laser was centered over this. Indocyanine green (12.5 mg) was injected intravenously and fluorescence patterns were recorded. Optimal perforators were chosen using real-time imaging and SPY-Q analysis software. The anterolateral thigh skin paddle was centered over perforators based on best relative perfusion values. The hand-held Doppler was not used to identify perforators. All flaps were elevated in standard fashion. Patient demographics, defect characteristics, reconstructive techniques, and clinical outcomes were assessed. Results: All 15 free flaps were raised with the assistance of laser-assisted angiography. Cutaneous Doppler did not aid in the design of the skin paddle. There was only 1 flap loss due to venous congestion. All donor defects were closed primarily without the need for a skin graft. Conclusions: Laser-assisted indocyanine green angiography using SPY-Q analysis software provides robust, intraoperative, objective data to optimize anterolateral thigh skin paddle design while potentially minimizing patient morbidity. Future studies will be needed to further evaluate the use of this new technology.

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Section: Discussionmentioning

confidence: 99%

128: Laser-Assisted Indocyanine Green Imaging Optimizes the Design of the Anterolateral Thigh Flap

Sacks

et al. 2011

Plastic and Reconstructive Surgery

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“…Although preoperative Doppler examination is commonly used to map out ALT cutaneous perforators, operator dependence and false positive are its main disadvantages. Shaw et al [22] speculated that false positives represented either pure muscular perforators, or signals from the main descending branch because of their proximity to the tip of the probe when the intervening layer of fat is minimal. Chiu et al considered that preoperative multi-detector computed tomographic angiography (CTA) could be performed to map perforator and evaluate the dominant vascularity in the suitable thigh before transferring chimeric ALT flaps [23].…”

Section: Discussionmentioning

confidence: 99%

Multipaddled Anterolateral Thigh Chimeric Flap for Reconstruction of Complex Defects in Head and Neck

Jiang

Guo

et al. 2014

PLoS ONE

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The anterolateral thigh flap has been the workhouse flap for coverage of soft-tissue defects in head and neck for decades. However, the reconstruction of multiple and complex soft-tissue defects in head and neck with multipaddled anterolateral thigh chimeric flaps is still a challenge for reconstructive surgeries. Here, a clinical series of 12 cases is reported in which multipaddled anterolateral thigh chimeric flaps were used for complex soft-tissue defects with several separately anatomic locations in head and neck. Of the 12 cases, 7 patients presented with trismus were diagnosed as advanced buccal cancer with oral submucous fibrosis, 2 tongue cancer cases were found accompanied with multiple oral mucosa lesions or buccal cancer, and 3 were hypopharyngeal cancer with anterior neck skin invaded. All soft-tissue defects were reconstructed by multipaddled anterolateral thigh chimeric flaps, including 9 tripaddled anterolateral thigh flaps and 3 bipaddled flaps. The mean length of skin paddle was 19.2 (range: 14–23) cm and the mean width was 4.9 (range: 2.5–7) cm. All flaps survived and all donor sites were closed primarily. After a mean follow-up time of 9.1 months, there were no problems with the donor or recipient sites. This study supports that the multipaddled anterolateral thigh chimeric flap is a reliable and good alternative for complex and multiple soft-tissue defects of the head and neck.

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“…Preoperative evaluation of the vessels of the flaps is of great value in order to guarantee a good anastomosis with the recipient vessels; otherwise, the failure rate increases. In some cases, lateral femoral circumflex vessels were deemed unsuitable for dissection because of their small size (<0.5 mm) [12]. In this study, the color Doppler ultrasound was facilitated to predicate the selection of flap and evaluate the defect's character with donor and recipient blood vessels.…”

Section: Discussionmentioning

confidence: 99%

Factors to Consider When Deciding on the Type of Free-Flap Reconstruction of Head and Neck Soft Tissue Defects

Aladimi

Han

et al. 2017

ORL

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Objectives: The aim of the study was to evaluate the functional and aesthetic outcomes on donor and recipient sites and to determine the effects of technical factors including flap thickness and vessel diameters measured by ultrasonography as well as the size of the defect and postoperative volume reduction of the flaps measured by magnetic resonance imaging (MRI). Methods: In patients who had undergone soft tissue reconstructive surgery between March 2013 and March 2016 using 55 anterolateral thigh flaps (ALTFs), 30 radial forearm flaps (RFFs), and 18 latissimus dorsi flaps (LDFs), color Doppler ultrasonography was performed to measure the thickness of the flap at the site of the perforator. Preoperative color Doppler ultrasound examinations of the blood vessel diameters of donor and recipient sites were carried out. Results: 97.1% of flaps showed complete survival and 2.9% complete failure (2 ALTFs and 1 LDF). The difference in flap volume of ALTFs, RFFs, and LDFs between MRI 1 (3-6 weeks) and MRI 2 (6-18 months) was 27.6, 17.9, and 36.1%, respectively. Conclusion: Proper selection of the flap is important for the optimization of the aesthetic and functional outcomes. Ultrasound, the surgeon's experience and the extension and nature of the defect play a key role in the selection of the flap.

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Preoperative Doppler assessment of perforator anatomy in the anterolateral thigh flap

Cited by 52 publications

References 10 publications

128: Laser-Assisted Indocyanine Green Imaging Optimizes the Design of the Anterolateral Thigh Flap

128: Laser-Assisted Indocyanine Green Imaging Optimizes the Design of the Anterolateral Thigh Flap

Multipaddled Anterolateral Thigh Chimeric Flap for Reconstruction of Complex Defects in Head and Neck

Factors to Consider When Deciding on the Type of Free-Flap Reconstruction of Head and Neck Soft Tissue Defects

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